=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023389731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSALINDA PARRA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2012
-----------------------------------------------------
Last Update Date | 01/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1184 BOCA CHICA BLVD
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-8307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-459-3409
-----------------------------------------------------
Fax | 956-542-9166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1184 BOCA CHICA BLVD
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78520-8307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-459-3409
-----------------------------------------------------
Fax | 956-542-9166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. GABRIELA SEIBEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-459-3409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 030317
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------